Activated Charcoal

Indications

Activated Charcoal is used for: Poisonings, Drug overdose, Gastrointestinal disorders

Adult Dose

Oral Acute oral poisoning Adult: 25-100 g as a single dose. For multiple-dose treatment: 50-100 g as an initial dose followed by not <12.5 g every hr. Alternatively, 25 mg every 2 hr or 50 mg every 4 hr. Minimum dose = 25 g Commonly used with sorbitol 25 g; multiple dose regimen 25 g PO q2hr or 50 g q4hr without sorbitol DO NOT give sorbitol after first dose due to risk for severe diarrhea; use aqueous solution Child: <1 yr: 1 g/kg/dose may repeat q4-6hr; 1-12 yr: 25-50 g/dose may repeat q4-6hr. Gastrointestinal disorders Adult: 0.975 - 3.9 g tid.

Child Dose

Oral Acute oral poisoning Child: <1 yr: 1 g/kg/dose may repeat q4-6hr; 1-12 yr: 25-50 g/dose may repeat q4-6hr.

Renal Dose

Administration

Contra Indications

Cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol, methanol poisoning; lithium, methionine; intestinal obstruction, anatomically-broken GI tract, haemorrhage or GI perforation. Concomitant use of charcoal with sorbitol: Patients with fructose intolerance; Childn <1 yr.

Precautions

Decreased peristalsis: administer within 1 hr of ingestion. Induce vomiting of ipecac syr before admin of charcoal to prevent adsorption of ipecac. Petroleum distillate, caustic ingestions may harm gastric lining upon induction of vomiting by charcoal. Limit admin of charcoal in sorbitol doses to prevent loss of fluid and electrolyte. Monitor for active bowel sounds before administering charcoal. Pregnancy.

Pregnancy-Lactation

Safe use during pregnancy and lactation has not been established.

Interactions

Reduces absorption of most drugs from GI tract. Decreases effectiveness of methionine via adsorption. Decreases ipecac effect.

Side Effects

Side effects of Activated Charcoal : Vomiting, constipation, diarrhoea, black stools, swelling of abdomen, bowel obstruction; platelet aggregation, charcoal embolism, thrombocytopenia, haemorrhage, hypoglycaemia, hypocalcaemia, hypothermia, hypotension (haemoperfusion with activated charcoal); blackening of teeth and mouth; hypernatraemia, hypokalaemia, hypermagnesemia (with concomitant admin with cathartics).

Mode of Action

Charcoal due to its large surface area, inhibits the GI absorption of toxic substances or irritants eg, aromatic or benzenoid-type substances through adsorption. As a laxative, the addition of sorbitol provides hyperosmotic environment thus causing catharsis. Moreover, charcoal interferes with the enterohepatic circulation of bile acids resulting to a lower cholesterol level.